An advisory committee of the US Centers for Disease Control and Prevention unanimously voted Wednesday to recommend the use of routine hepatitis A vaccination for all homeless people ages 1 year and older to protect them against infection. The CDC is expected to approve the committee's recommendation.
Hepatitis A is a disease of the liver caused by a virus. Stomach pain, low appetite, nausea, fatigue and jaundice are common symptoms, which usually end within two months of infection. People usually get sick when they touch a door handle or surface that has been contaminated. Eating contaminated food or drinking contaminated water can also cause sickness. The virus can also be spread through sexual contact or from generally poor sanitary conditions or, if they are drug users, via contaminated needles and other paraphernalia.
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Ten states have reported more than 6,500 hepatitis A infections from January 2017 to October 2018 and homeless people made up more than 40% of the cases occurring in San Diego and Utah, according to the CDC. In Michigan, Kentucky, West Virginia and Tennessee, more than 10% were among homeless people. Not all states include complete information about those who are infected, the agency noted.
The more than 6,000 infections reported by the CDC led to more than 3,800 hospitalizations and an estimated 70 deaths. Sick once, you are protected for life against reinfection. Hepatitis A is also vaccine-preventable. The vaccine comes in the form of a shot, usually given in two doses.
The hepatitis A vaccine first became available in the United States in 1995 and currently there are three licensed vaccines, according to the CDC. Following that year, rates of infection declined by more than 95%. After a long downward trend, the first increase between 2012 and 2013 (1,562 and 1,781 reported cases, respectively), was due to a large multi-state outbreak. Between 2015 and 2016, the reported cases increased by 44.4% from 1,390 in 2015 to 2,007 cases in 2016. After adjusting for under-reporting, the estimated number of new infections in 2016 was 4,000 with this increase due to two outbreaks linked to imported foods.
The current hepatitis A vaccine recommendation includes these at-risk groups: travelers, men who have sex with men, users of drugs, people with clotting-factor disorders, those who work with nonhuman primates, people who anticipate a close personal contact with an international adoptee from a hepatitis A endemic country, and people with chronic liver disease. The CDC also recommended the vaccine for healthy people between the ages of 12 months and 40 years after exposure to the disease. With the new recommendation, homeless people will be included on this list.
Dr. Mona Doshani, a scientist in the division of viral hepatitis within the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the CDC, noted in her presentation to the advisory committee that analysis of data from the US Vaccine Adverse Event Reporting System for a single year ending in 1996 showed more than 400 cases of side effects and 93 serious adverse events among 6 million doses of the hepatitis A vaccine.
On a single night, more than 553,000 people are homelessness in the United States, according to government reports. In a given year, about 3 million people or 1% of the population, are homeless. Just under two-thirds stay in emergency shelters or transitional housing programs, while a third live outside. These homelessness numbers are on the rise, according to the CDC.
Homelessness is associated with a two to three times higher odds of infection with hepatitis A and, if infected, a two to four times higher odds of severe outcomes, such as hospitalization or death, according to a not-yet-published study performed in San Diego County, site of the largest recent outbreak.
The vaccine would be dispensed at clinics where homeless people receive health care and in some states would be covered by Medicaid, according to the CDC.